International Animal Rescue Organization

Adopting a Mexican dog

We love to be able to bring the dogs we rescue to the best homes we can find and have a suitably stringent adoption process.

The SAMM application process involves:

Completed adoption application (below)

Vet and reference verification

Phone interview

Home Visit

If approved, transport arrangements are made.

Adoption Form

Name of dog you are applying for:

All potential adopters/foster homes are screened for suitable placement of animals. SAMM may refuse placement of an animal for any reason. By submitting this application, you give permission for SAMM to investigate and confirm the information that you provide. All forms become the property of SAMM upon submission.

Release for Veterinary Reference: (to be completed by potential adopter/foster)
I,
, hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to SAMM.

My current veterinarian is located at
:

and can be reached at telephone number:

All form items marked * MUST be completed or your application will not be submitted.
Incomplete applications may not be considered.

1

Adopter Name*

2

Date of Birth* (MM/DD/YYYY)

3

Email Address*

4

Street Address*

5

City, State, Zip*

6

Home Telephone

Please continue with the following

7

Employer Name

8

Employer Address

9

Employer Phone

10

Years working for current employer

11

Spouse/Partner Name

12

Spouse Employer

13

Employer Phone

14

Please provide two references
(name, address and telephone number)

15

I live in

16

Do you have a fenced yard?

yes

no

17

Type of fence

wood

chain

link

18

Fence Height:

19

How long at current address:

years
months

20

Do you own your home?

yes

no

21

Do you plan to move in the next 12 months?

yes

no

22

If Yes, where:

23

If you rent: Does your landlord allow pets?

yes

no

24

Is a pet deposit required

yes

no

25

How much: $ /per pet or $ /per household? Size/Weight limit?

26

Limit to number of pets?

yes

no

27

Name of Apartment Complex or Landlord:

28

Phone:

29

Number of adults in household:

30

Number of children in household and ages:

31

Do all of the adults in the household consent to this adoption?

yes

no

32

Are you or your spouse a student?

yes

no

33

If yes, full time or part time

full

part time

34

Do you or your spouse travel frequently?

yes

no

35

If yes, how often:

36

Does anyone living in your house have asthma?

yes

no

37

Does anyone living in your house have allergies?

yes

no

38

If yes, to what?

PET OWNERSHIP

1

This pet will be kept:

mostly inside

mostly outside

totally inside

totally outside

2

How long will this pet be left home alone during the day?

hrs
days

3

Where will this pet be kept while you are at work or away from home?

4

Where will this pet sleep at night?

5

Are you willing/able to enroll this pet in an obedience class if needed or advised?

yes

no

6

Are you willing/able to purchase and use a cage/crate if needed or advised?

yes

no

7

Do you have a pet door?

yes

no

8

Do you plan to chain this pet in the yard?

yes

no

9

Can you keep this pet away from other pets in the house for one week?

yes

no

no other pets

10

How will you teach housebreaking (if necessary)?

11

Who are you getting this animal for?

Self
As a gift for

12

What will you do with this pet if you have to move?

13

What will you do with this pet when you need to travel?

14

Do you want this pet to be spayed/neutered?

yes

no

15

Why would you like to add a dog to your family at this time?

16

What qualities are you looking for in the dog that you would like to adopt?
Be very specific (very active vs. couch potato; want to do obedience work/agility/flyball; etc.) so we can make the best match possible

17

What do you expect to be the worst and/or hardest part about adopting a rescued dog, and how do you plan to deal with/address it?

18

Does anyone have any concerns about adopting this pet? If so, who and what are the concerns?

yes

no

19

Do you give permission for a SAMM representative to visit your home prior to adoption to do a home check and after adoption to do follow up checks on your adopted pet?

yes

no

20

How much would you be willing to spend on vet care in the event of an emergency (example: dog swallows something and requires surgery)

21

Under what circumstances would you have a dog euthanized?

22

What plans have you made for your pets in the event you should pass away before they do?

PET OWNERSHIP HISTORY

1

Have you ever adopted from a humane group or shelter?

yes

no

2

If yes, whom did you adopt from:

3

When?

4

Phone #:

5

Have you ever given an animal up for adoption or gotten rid of an animal?

yes

no

6

If so, why?

7

What did you do with the animal?

8

Are all the pets in your household current on their shots?

yes

no

no other pets

9

Are all your dogs on Heartworm preventative?

yes

no

10

What kind of Heartworm Preventative do you use?

11

What is the date of the last Heartworm preventative given?

12

Have any pets in your household been diagnosed with infectious diseases or conditions?

Heartworms

yes

no

Distemper

yes

no

Parvovirus

yes

no

Please list all pets currently owned OR owned within the last ten years

1

name

Dog or Cat

cat

dog

Breed

Male or Female

male

female

Age

Length of ownership

Was it spayed/neutered?

yes

no

If not, why:

Do you own the pet now?

yes

no

If no, what happened to it?

This pet was kept:

mostly inside

mostly outside

totally inside

totally outside

2

name

Dog or Cat

cat

dog

Breed

Male or Female

male

female

Age

Length of ownership

Was it spayed/neutered?

yes

no

If not, why:

Do you own the pet now?

yes

no

If no, what happened to it?

This pet was kept:

mostly inside

mostly outside

totally inside

totally outside

3

name

Dog or Cat

cat

dog

Breed

Male or Female

male

female

Age

Length of ownership

Was it spayed/neutered?

yes

no

If not, why:

Do you own the pet now?

yes

no

If no, what happened to it?

This pet was kept:

mostly inside

mostly outside

totally inside

totally outside

4

name

Dog or Cat

cat

dog

Breed

Male or Female

male

female

Age

Length of ownership

Was it spayed/neutered?

yes

no

If not, why:

Do you own the pet now?

yes

no

If no, what happened to it?

This pet was kept:

mostly inside

mostly outside

totally inside

totally outside

Where did you hear about SAMM?

Important! You MUST tick this box to send your application.

By ticking this box you effectively sign and confirm that all the information in this application is correct and complete to the best of your knowledge. Any information supplied is used soley in connection with the SAMM adoption process. We do not share your information with any third party or contact you concerning matters other than the adoption.

Please check you have answered all relevant questions prior to sending.

Bruno's looking for a home

Rescues since 2001

Neuters & Spays

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To donate using a credit card, please click the above button and look to the lower left of the PayPal login information, where you can input the credit card information. SAMM is a 501(c)(3) nonprofit organization. Contributions to SAMM in the United States are tax-exempt to the extent provided by law. Tax ID 56-2630399